Varicose veins

Disease Description (Causes and Symptoms)

• Definition and pathophysiology: Varicose veins of the lower extremities are a condition in which the veins become abnormally dilated and tortuous because blood flows backward and venous pressure rises due to impaired valve function in the superficial veins of the lower extremities. When venous reflux and chronic venous hypertension persist, lower-extremity edema, dermatitis and induration, hyperpigmentation, structural changes in fat and skin (liposclerosis, lipodermatosclerosis), and, in severe cases, skin ulcers may occur.
• Main causes (risk factors): Family history (genetic predisposition; maternal-dominant pattern has been reported), pregnancy (hormonal changes), increasing age, female sex, obesity, prolonged standing or sitting, oral contraceptives, previous phlebitis/deep vein thrombosis, conditions causing increased intra-abdominal pressure, tight clothing, etc.
• Main symptoms: Clearly protruding blood vessels in the legs (cosmetic concerns), heaviness and fatigue, pain or dull aching pain, nighttime cramps, burning, tingling, or itching, edema, reduced skin tension and hyperpigmentation, superficial thrombophlebitis, and, in severe cases, skin ulcers.
• Diagnostic summary: Visual observation while standing (dilated superficial veins), physical examination (presence of reflux, CEAP classification), and Doppler (venous Doppler) and ultrasound of the abdominal and lower-extremity veins (duplex ultrasound) to evaluate the location and extent of reflux and whether the deep veins are involved.

Treatment Methods

• Conservative treatment (initial and adjunctive)
  • Lifestyle measures: Avoid prolonged standing or sitting, elevate the legs (above the heart during rest and sleep; approximately 15 cm is recommended), exercise regularly (promote venous return through the calf muscle pump), manage weight, and avoid tight clothing.
  • Compression therapy: Compression stockings providing approximately 20–30 mmHg (moderate compression) are recommended (put them on immediately after getting up in the morning and wear them during activity; wearing them for at least 2–3 weeks after a procedure is recommended). The stockings should fit properly without wrinkles.
  • Medication: Venoactive drugs to improve vascular symptoms (use of diosmin/hesperidin preparations, for example, has been reported), anti-inflammatory analgesics, and topical treatment and antibiotics for ulcers (when infected).
• Interventional/procedural treatment (for symptoms, cosmetic concerns, or complications)
  • Sclerotherapy: Used for small varicose veins or recurrent or residual veins (liquid or foam). Advantage: No anesthesia or incision is required in an outpatient setting. Disadvantage: Failure to comply with compression therapy may increase the risk of recurrence and thrombosis.
  • Percutaneous endovenous occlusion: Occlusion using radiofrequency ablation (RFA) or laser (EVLA)—minimizes skin incisions, provides cosmetic benefits, and allows rapid recovery. Long-term recurrence rates require further study.
  • Surgical treatment: High ligation and stripping, and microphlebectomy. Advantage: Minimizes recurrence, particularly when treating the site of inguinal valve reflux. Disadvantages: Possible need for anesthesia, hospitalization, and incisional scars.
  • Treatment for thrombotic complications: Superficial thrombophlebitis is treated conservatively and locally; if deep vein thrombosis (DVT) is suspected, standard anticoagulant therapy is used (as directed by a specialist).
• Post-procedure care: Early ambulation is recommended, appropriate compression stockings should be worn, and symptoms of infection or thrombosis should be monitored.
• Prognosis: The condition may have a chronic course, but appropriate treatment can relieve symptoms and prevent complications. Because recurrence is possible, lifestyle management and regular follow-up are necessary.

Checklist Before an Outpatient Visit (Including Examples of Items to Prepare and Questions)

• Items to prepare
  • A list of currently used medications and supplements (including anticoagulants).
  • Past medical history (especially previous DVT, surgical history, and pregnancy history) and family history (whether varicose veins are present).
  • Copies or CDs of previous test results and images (such as ultrasound), if available.
  • A record of when symptoms began and how they have changed (degree of edema, nature of pain, nighttime cramps, etc.) and photographs of the legs (front and side views taken while standing).
  • Information about weight and occupation (whether you stand or sit for long periods).
  • If pregnancy is possible, confirm whether you are pregnant (inform the doctor in advance if you are pregnant or planning a pregnancy).
• Materials and records to show the doctor during the outpatient visit
  • The times when symptoms occur (whether they worsen in the morning or evening), whether compression stockings are worn and what type, and limitations in daily life.
• Prepare for a basic examination during the outpatient visit: Observation while standing, examination of areas of compression or injury, and the possibility of scheduling a Doppler ultrasound.

Examples of General Questions to Ask the Doctor

• "What treatment options do you recommend, and what are the advantages and disadvantages of each?"
• "What are the common side effects and precautions for this medication (or procedure)?"
• "How long will it take to return to daily life after treatment, and what will the recovery process be like?"
• "How likely is recurrence, and what lifestyle habits can reduce the risk of recurrence?"
• "How does the treatment strategy differ if I am pregnant or planning to become pregnant?"

Examples of Condition-Specific Questions

• "In my case (presenting symptom photographs and ultrasound results), is compression therapy sufficient, or is a procedure (such as radiofrequency treatment, laser treatment, or sclerotherapy) recommended?"
• "How long should I wear compression stockings after sclerotherapy (for example, at least 2–3 weeks), and what care should I follow to prevent side effects (hyperpigmentation and thrombosis)?"